Adolescents with insulin-dependent diabetes mellitus (IDDM) face increasing responsibilities for managing their own treatment. For some, implementing their treatment regimen enhances diabetes self-efficacy beliefs because they welcome the chance to exert control over their illness. Other adolescent patients, however, feel overwhelmed and helpless. We developed the self-efficacy for diabetes scale (SED) with a sample of adolescent boys (n = 34) and girls (n = 34) with IDDM. High reliability (internal consistency) and evidence for criterion validity were obtained for this measure, because SED scores predicted metabolic control. In addition, construct validity was established, because SED scores were related to theoretically relevant measures of locus of control and self-esteem. Although they showed similar expectancies for diabetes self-efficacy, girls had significantly positive correlations between their SED scores and metabolic control, whereas boys did not. We offer a new instrument for studying adolescent patient perceptions and physical health.

In previous studies of the antibody response to hepatitis B vaccine in 598 subjects who received a full course of vaccination, we observed a bimodal response, with about 14 percent producing less than approximately 1000 radioimmunoassay (RIA) units. An analysis of the major histocompatibility complex (MHC) HLA and complement types of 20 of the subjects with the lowest responses indicated a greater-than-expected number of homozygotes for the extended or fixed MHC haplotype [HLA-B8, SC01, DR3]. This finding suggested that the lack of a normal response was a recessive MHC-linked trait. In this study, we prospectively vaccinated five homozygotes and nine heterozygotes for this haplotype in the expectation that the homozygotes would produce much lower levels of antibody than the heterozygotes. When the antibody response was assessed two months after the third injection, four of the five homozygotes had produced very low levels (approximately 1000 units or less) of antibody (mean, 467 RIA units; range, less than 8 to 1266), whereas all nine heterozygotes produced more than 2500 RIA units (mean, 15,608; range, 2655 to 28,900) (P less than 0.01). We conclude that the usual response to hepatitis B surface antigen is due to the presence of a dominant immune-response gene in the MHC and that a low response is due to the absence of such a gene and the presence on both chromosomes of MHC haplotypes (such as [HLA-B8, SC01, DR3]) that indicate such a response.

In prepubertal children, insulin lispro given before meals is safe and significantly lowers postprandial glucose levels after breakfast and dinner compared with regular human insulin, and insulin lispro given after the meal provides similar benefits as regular human insulin before the meal.